Book Review

Why Psychiatry Is a Branch of Medicine

N Engl J Med 1993; 329:1134October 7, 1993

Article

Why Psychiatry Is a Branch of Medicine
By Samuel B. Guze. 147 pp. New York, Oxford University Press, 1992. $24.95. ISBN: 0-19-507420-3

The title of the book encapsulates its central thesis -- that psychiatry is a branch of medicine. This proposition might seem to be a tautology, yet it reflects a question at the very core of psychiatry: What are the appropriate purview and perspective of the field?

Guze's thesis centers on the importance of applying the “medical model” to mental illness. He has been a leading proponent of this perspective over the past 30 years, and this book is a comprehensive summary of his views. Simply put, the medical model means that the “concepts, strategies, and jargon of general medicine are applied to psychiatric disorders: diagnosis, differential diagnosis, etiology, pathogenesis, treatment, natural history, epidemiology, complications, and so on.” He points out that the medical model both distinguishes psychiatry from other disciplines that deal with mental disorders and brings it into the fold of general medicine.

It has sometimes been assumed that a necessary condition for applying the medical model is to establish that psychiatric disorders fall within the definition of “real” (i.e., medical) diseases. Guze responds by noting the lack of any well-demarcated definition of disease elsewhere in medicine. He stresses the advantages of applying the methods and concepts of general medicine in thinking about psychiatric patients. These include a workable classification of disorders, the concepts of differential diagnosis, clinical course, and differential treatment response, and epidemiology.

Guze also considers the implications of the medical model with respect to research strategies, diagnostic issues, biologic psychiatry and neuroscience, psychotherapy, philosophical issues, and education and training. The discussions of such a wide range of issues in so little space are necessarily brief, whetting the reader's appetite but often failing to satisfy it.

Overall, Guze's arguments are persuasive. He makes a strong case for the medical model of psychiatric disorders and provides hope for continuing its benefits in psychiatry. The book should be of interest to students and clinicians in and outside psychiatry who are interested in understanding the underpinnings and implications of the medical model.

Michael B. First, M.D.
Columbia University, New York, NY 10032